Medical Insurance in Ajman

Medical insurance helps eligible Ajman residents access covered healthcare services through the provider network assigned to their policy. The available benefits, limits, co-payments and exclusions depend on the selected plan and its schedule of benefits.

Since 1 January 2025, employers must arrange health insurance for eligible private-sector employees and domestic workers in Ajman as part of applicable employment and residence-permit procedures.

Who May Need Medical Insurance?

Medical coverage may need to be arranged for:

1. Private-Sector Employees: Employers are responsible for arranging the required medical insurance for eligible employees.
2. Domestic Workers: Employers or sponsors must arrange suitable medical coverage for eligible domestic workers under their sponsorship.
3. Self-Sponsored Residents: Investors, freelancers and other eligible self-sponsored residents may need to arrange their own medical insurance.
4. Family Dependants: Sponsors may request separate medical coverage for spouses, children or other eligible dependants who are not insured under another valid policy.

What May Medical Insurance Cover?

Depending on the issued policy, benefits may include:

1. Outpatient Consultations: Eligible consultations with general practitioners and approved specialists within the assigned medical network.
2. Diagnostic Services: Medically necessary laboratory tests, imaging and other investigations, subject to policy limits and approval requirements.
3. Prescribed Medicines: Approved medicines may be covered according to the applicable formulary, benefit limits and co-payments.
4. Inpatient Treatment: Eligible hospital admissions, surgeries and related medical care, subject to medical necessity and pre-authorisation.
5. Emergency Treatment: Emergency medical services may be covered according to the policy conditions and geographical limits.
6. Maternity Benefits: Eligible maternity services may be included, subject to limits, co-payments, waiting periods and other policy conditions.

How to Choose Medical Insurance:

Review these important policy details:

1. Medical Network: Confirm that suitable hospitals, clinics, pharmacies and specialists are available in Ajman or nearby emirates.
2. Coverage Limits: Review the annual policy limit and any separate limits applying to medicines, maternity or other benefits.
3. Co-payments and Deductibles: Check how much the insured member may need to contribute when receiving medical services.
4. Pre-authorisation: Understand which treatments, investigations, medicines and hospital admissions require approval before the service is provided.
5. Geographical Coverage: Check whether the policy provides access only within a limited network, across other emirates or outside the UAE.
6. Exclusions and Waiting Periods: Review treatments that are excluded, restricted or available only after a stated waiting period.

How to Request Medical Insurance:

Follow these steps:

1. Provide the Applicant’s Details: Enter the applicant’s personal, identification, contact and residency information.
2. Provide Sponsor Information: Submit the applicable employer, family sponsor or self-sponsorship details.
3. Complete the Medical Declaration: Disclose existing medical conditions, previous treatments and other requested information accurately.
4. Review the Available Coverage: Check the benefits, provider network, limits, co-payments and exclusions.
5. Submit the Required Documents: Provide the requested identification, residency and supporting records.
6. Review the Quotation: Confirm the premium and policy conditions before completing the application.

Documents Required:

You may need the following documents:

1. Emirates ID
2. Passport copy
3. Residence visa copy or visa application details
4. Employer or sponsor information
5. Employment or domestic-worker details, where applicable
6. Previous medical insurance details, if available
7. Medical declaration or supporting reports, if requested

Why Choose Al Buhaira Insurance?

Eligible applicants and members can access:

1. Online Medical Quotation: Applicants can submit their personal and medical information through the online quotation journey.
2. Ajman Medical Network Search: Members can search healthcare providers according to their assigned network, provider type and speciality.
3. In-House and TPA Networks: Medical policies may use an Al Buhaira network or an appointed Third Party Administrator, depending on the issued plan.
4. Medical Insurance Support: Assistance is available for policy enquiries, renewals, endorsements, network questions, medical approvals and reimbursement claims.

Frequently Asked Questions: